Provider Demographics
NPI:1679694178
Name:FOOT & ANKLE CLINIC OF ST. PETER, INC.
Entity type:Organization
Organization Name:FOOT & ANKLE CLINIC OF ST. PETER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCHELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCABE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:507-934-3102
Mailing Address - Street 1:316 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PETER
Mailing Address - State:MN
Mailing Address - Zip Code:56082-2023
Mailing Address - Country:US
Mailing Address - Phone:507-934-3102
Mailing Address - Fax:
Practice Address - Street 1:316 S 3RD ST
Practice Address - Street 2:
Practice Address - City:SAINT PETER
Practice Address - State:MN
Practice Address - Zip Code:56082-2023
Practice Address - Country:US
Practice Address - Phone:507-934-3102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN421213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN253725700Medicaid
MN480034553Medicare PIN
MNT40001Medicare UPIN
MN5506350001Medicare NSC
MN253725700Medicaid